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General NPI Number Information
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NPI Number | 1497860464
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Entity Type | Organization
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Legal Business Name | NICHOLAS BRADLEE DPM PC
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 11/20/2012
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Provider Practice Location Address
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Address Line | 1909 LIVERNOIS
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City | TROY
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State | MI
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Zip | 48083
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Country | US
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Telephone | 248-244-9565
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Fax | 248-244-8183
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Provider Business Mailing Address
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Address Line | PO BOX 1029
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City | TROY
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State | MI
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Zip | 48099-1029
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Country | US
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Telephone | 248-244-9565
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Fax | 248-244-8183
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Authorized Official
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Title or Position | OWNER
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Name | NICHOLAS BRADLEE
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Credential | DPM
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Telephone | 248-244-9565
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | NB000558
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License Number State | MI
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